My father is 68 next week and a fit and healthy man. He has

Customer Question

My father is 68 next week and a fit and healthy man. He has a good health history and does not smoke. He does not take any medication or suffer from any chronic ailments. Last week he was sea fishing. He spent hours focussed on a rod tip. He wore sunglasses to protect from the bright glare off the water. He was also thrown about on the boat a bit with choppy waters. He does not recall any head injuries from this. On his return home from 3 days fishing he noticed some visual differences. Blurred vision which he put down to tiredness. The following morning it was worse. He had blurred/double vision. It continued to the Monday and we went to A&E. He has had heart test, head scan, blood tests and eye examination and physical examination and been told that all are entirely normal. The following day he went to Moorfields eye hospital and had numerous eye tests and a scan and was once again told everything was normal. They suggested it could be an eye muscle problem and suggested he visit the eye clinic of the local hospital. His vision has not improved but subsequent to his moorfields visit he does describe messy morning left eye and a feeling of warmth and dull ache around the area of this eye. It also looks a bit inflamed. His vision corrects when covering one eye (either eye) and he also has improved vision if look in a different direction or if lifting the eyelid. My questions are: Is eye strain or infection the most likely cause and if so what can we expect in terms of timing for the resolution of his symptoms? Given the tests he has had which are all clear, I presume most if not all of the nasty potentials (stroke, tumour, diabetes etc) can be ruled out. Are there any other possible nasties that we need to rule out? It is a week now and he has no improvement and no answers. He intends on spending money with a private appt in Harley Street but what specialist would be the most appropriate to see given the tests and non findings to date? If an infection is likely / probable given the latest symptoms of hot sensation and messy eye, dull ache etc, would antibiotics be adviseable and what type?

Dr. Dan B. :Hello and thanks for your question. It sounds as though your father maybe suffering from an imbalance in the muscles that move the eye and that align the eyeball straight ahead with the other eyeball. This can cause the double vision he complains of and explains why his symptoms improved or resolved after one eyeball is covered.

Dr. Dan B. :this doesn't necessarily sound like infection. I would recommend that he see a pediatric ophthalmologist who is also a strabismus specialist. They're often called pediatric specialists because most often kids have eyes that are misaligned. He needs to have a thorough evaluation by this subspecialist about the way his eyes move. Alternatively, he can see a neuro ophthalmologist who can also very ably diagnose this. Does this make sense

Dr. Dan B. :Does this information help address your concerns? Do you have any other questions about this? It appears as though you are not in the chat room currently. I am happy to be able to help you today. If you need any clarification regarding anything I've said, please let me know and I will be happy to address your concerns as you voice them. If your concerns have been resolved...Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!

Customer:

can you refer to the questions I asked in my first email?

Dr. Dan B. : of course without being able to examine him, I cannot answer your questions definitively. However, from what I can tell, this is not caused from eye strain or infection. As to how long it would take this resolve, it depends on the specific etiology of the muscle imbalance. There are many causes and reasons why some one may muscle imbalance in the eyes.

Dr. Dan B. :While on the basis of those tests, you can rule out many of those things you said, the imaging cannot rule out some very small strokes that may have taken place in the brain that sometimes cannot be picked up by imaging. It is possible that this muscle imbalance is related to a small stroke to the nerves that control the muscles that move the eyes.

Dr. Dan B. :For this reason, I would recommend seeing a neuro-ophthalmologist, and if you cannot see one of these, I would recommend a pediatric ophthalmologist or strabismus specialist. These are the two specialists that are going to have the most input and the most able to rule out "nasties".

Dr. Dan B. :I hope that I was able to answer your questions. You have any further questions about what I have said?

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